Naloxone (Narcan): How to Get It, How to Use It, and When to Call 911

Naloxone — sold under the brand name Narcan — is an opioid antagonist that reverses opioid overdoses by displacing opioids from receptors in the brain and restoring breathing. It does not work on overdoses involving alcohol, benzodiazepines, stimulants, or other non-opioid substances, but for opioid overdoses (heroin, fentanyl, oxycodone, hydrocodone, morphine, methadone, and many others) it is the difference between someone dying and someone being given a chance to enter treatment. Tens of thousands of overdose deaths are prevented in the United States each year by laypeople — not paramedics, not doctors — administering naloxone.

Since March 2023, Narcan nasal spray has been available over the counter in the United States. You no longer need a prescription. You no longer need a special license. This guide is the practical version for anyone who might encounter an overdose: family members of people with opioid use disorder, roommates of people in recovery, teachers, coaches, bartenders, gym staff, anyone.

If you carry naloxone, you may go your entire life without using it. If you do use it, you will likely save a life. The asymmetry is the reason to carry it.

How to Recognize an Opioid Overdose

Opioid overdoses kill by suppressing the brain''s drive to breathe. The signs you would see in someone overdosing:

• Unresponsive. They do not wake up when you call their name or shake their shoulder. If you rub a knuckle hard against their breastbone (a sternal rub), they do not react.
• Slow, shallow, or stopped breathing. Normal adult breathing is 12-20 breaths per minute. An overdosing person may be at 4-6 breaths per minute, gasping irregularly, or not breathing at all.
• Pinpoint pupils. The pupils are unusually small even in a dim room.
• Pale, bluish, or grayish skin. Especially noticeable around the lips and fingertips.
• Choking or gurgling sounds. Sometimes called the "death rattle" — fluid in the throat that the person cannot swallow.
• Limp body. Muscle tone is gone.

If you see any combination of these signs and there is even a possibility opioids are involved, act. Naloxone is safe to give to someone who is not actually overdosing on opioids — it will not harm them. The mistake to avoid is hesitation. Most overdose deaths happen because no one was there to act in the first ten minutes.

What To Do — Step by Step

1. Try to wake them up. Call their name. Shake their shoulder. Rub knuckles hard against their breastbone. If they respond, monitor them — they may still be at risk and you may need to call for help, but they are not yet in a full overdose.

2. Call 911. Do this even if you are going to give naloxone. The medication''s effects can wear off in 30-90 minutes — shorter than how long many opioids stay in the body — and the person can re-overdose. Emergency medical services are also equipped to handle complications. Tell the dispatcher: "I believe someone is overdosing on opioids. I am going to give Narcan."

3. Give the first dose of naloxone. For the over-the-counter Narcan nasal spray:

• Lay the person on their back.
• Tilt their head back slightly.
• Hold the Narcan device with your thumb on the plunger and two fingers on either side of the nozzle.
• Insert the nozzle into one nostril until your fingers touch the bottom of the person''s nose.
• Press the plunger firmly to release the full dose into that nostril.
• The device is single-use — one press releases the full dose.

4. Give rescue breaths if they are not breathing. If the person is not breathing at all, give rescue breaths between naloxone doses: tilt their head back, lift their chin, pinch their nose, give one full breath every 5-6 seconds. If you are CPR-trained and there is no pulse, start chest compressions.

5. Wait 2-3 minutes. If no response, give a second dose — in the other nostril. The high potency of fentanyl in the current U.S. drug supply means multiple doses are often needed. Continue giving doses every 2-3 minutes until the person responds or emergency services arrive. Most overdoses respond to 1-2 doses; fentanyl overdoses sometimes require 3-5.

6. Put them in the recovery position. Once they respond and are breathing, gently roll them onto their side so they will not aspirate vomit. The recovery position: knee on the top leg bent forward, top arm bent under the head as a cushion, bottom arm tucked underneath. This keeps the airway clear.

7. Stay with them until help arrives. Do not leave the person alone. The naloxone may wear off before all of the opioids do, and they can re-overdose. Talk to them. Keep them warm. Reassure them — they may be confused, scared, or in withdrawal.

What to Expect After Narcan

Reversing an overdose is not the same as making the person feel good. When naloxone displaces opioids from receptors, the brain experiences sudden withdrawal, which can be intense and unpleasant. Common reactions in the minutes after revival:

• Confusion and disorientation — they may not understand what just happened
• Agitation or hostility — particularly if they are now in withdrawal
• Body aches, sweating, shivering, nausea, vomiting
• Strong cravings to use again, which paradoxically makes the post-overdose hours dangerous for another overdose
• Embarrassment, shame, or anger — common emotional responses

Stay calm. Do not lecture them. Do not interrogate them about what they used. The goal is to keep them safe and oriented until paramedics arrive. Many people will refuse hospital transport — that is their right, but encourage transport because of the risk of re-overdose and the opportunity for a treatment referral. Hospitals in many states are now equipped to start buprenorphine in the emergency department, which can be the start of recovery.

Good Samaritan Laws

Most U.S. states have Good Samaritan laws that protect people who call 911 to report an overdose from certain drug-related charges. The specifics vary:

• 47 states plus D.C. have some form of overdose Good Samaritan law as of 2026.
• Common protections: immunity from possession of small amounts of a controlled substance, paraphernalia possession, and being under the influence — both for the caller and the person who overdosed.
• Common limits: the laws typically do not protect against distribution, trafficking, manufacturing, or weapons charges. They do not exempt you from active warrants or parole violations.
• States WITHOUT a Good Samaritan law as of 2026: Wyoming and Kansas (verify current law for your jurisdiction; this changes).

Fear of arrest is one of the top reasons people delay or skip calling 911 during an overdose. The math: if a friend is dying, the worst case of calling is a misdemeanor that the Good Samaritan law will likely shield you from. The worst case of not calling is your friend dies. Always call.

Where to Get Naloxone — Often Free

Pharmacies. Over-the-counter Narcan nasal spray is on the shelf at CVS, Walgreens, Walmart, Rite Aid, Kroger, Costco, and most independent pharmacies. Retail price is typically $45-$60 for a 2-dose pack. Many insurance plans cover it at no copay even though it is OTC — ask the pharmacist to run it through your insurance.

Free Naloxone Distribution — Most Common Channels:

• State and county health departments — most have a naloxone-by-mail or free pickup program. Search "[your state] naloxone program."
• Harm reduction organizations — most cities have at least one organization (often syringe service programs) that distributes naloxone free of charge, no questions asked. Find local providers via NEXT Distro''s locator or by searching the North America Syringe Exchange Network.
• NaloxoneForAll.com — a national mail-order program that ships free naloxone to all 50 states. Order online; arrives in 1-2 weeks.
• Many universities, schools, and workplaces now stock naloxone — ask your HR department, student health services, or facilities team.
• Project Lazarus, NEXT, Remedy Alliance, and other non-profits — distribute free naloxone with no eligibility requirements.

If cost is the only barrier between you and carrying naloxone, the cost barrier can be eliminated today by any of the above. Order it. Tomorrow your house has it.

Storing and Replacing Naloxone

• Store at room temperature (between 59-77°F / 15-25°C). Do not leave it in a hot car for extended periods or in a freezer.
• Expiration is typically 2-3 years from manufacture. Expired naloxone is still mostly effective — research shows potency lingers well past the printed date — but replace it when you can.
• Keep at least two doses readily available. Multi-dose response is common, especially with fentanyl in the supply.
• Keep it where it will be found in an emergency: in a bedside drawer, a kitchen cabinet, a glove compartment, a bag you carry.

Talking to a Loved One About Carrying It

If you are buying naloxone because someone you love is using opioids — or is in recovery and could relapse — the conversation can feel loaded. Approaches that work better than warnings or accusations:

• "I bought some Narcan and I want to keep it here. I want you to know it is in this drawer in case you ever need it for yourself or anyone."
• "I love you, and the world has fentanyl in it. I keep this here the same way I keep an EpiPen here for our kid''s peanut allergy."
• "I am not asking what you are doing. I just want you to be able to come home."

Naloxone is not a permission slip to use. It is the same logic as a smoke alarm — you hope you never need it, and the cost of having it is much smaller than the cost of not. If your loved one is in active use or recently in recovery, having it in the house may be the most important thing you do this year.

After the Reversal: The Treatment Window

An overdose is one of the only times a person with opioid use disorder is fully in contact with what their use is doing to them. Treatment researchers call this the "reachable moment." If you are with someone who has just been revived and they are willing to consider treatment, act fast — the window often closes within hours.

• Hospital ED-initiated MAT. Many emergency departments will start buprenorphine and connect the patient with outpatient follow-up before discharge. Encourage hospital transport for this reason alone.
• Same-day treatment admissions — see [[how-to-get-into-rehab-today|how to get into rehab today]] for the steps.
• Bridge programs offered by some treatment centers — they will see the patient within 24 hours of an overdose and begin medications, then transition to a longer-term plan.
• Peer recovery support — many hospitals now have peer recovery specialists on staff who meet patients in the ED after an overdose.

If you carry naloxone and you reverse an overdose, you do not need to feel like a hero or like a failure depending on whether the person enters treatment afterward. You did the only thing that mattered: you gave them another day to make that choice. Read [[medication-assisted-treatment-guide|the MAT guide]] for what those next-day options look like, and [[fentanyl-crisis-guide|the fentanyl crisis guide]] for context on why this medication has become essential to carry.